When you are being trained for nocturnal I understand first they train you to do short txs and then they advance to the nocturnal training. Can someone refresh my memory on how they make the transition?
I don’t know if everybody does it the same, but where I live, we train doing short daily treatments 5 days per week on weekdays (about 9AM to 1 PM or whatever time it takes). Then we go home doing short daily tmts for a few weeks. We don’t do any nocturnals until we have spent 3 nights at the hospital with our training nurse there too (nights only). They do blood work at that time to see if we need to add anything to our dialysate, but the main point of it is to make sure we can wake up to any alarms and respond appropriately.
Pierre
Could you go straight into nocturnal without the few weeks of SDD or is there a purpose for doing the SDD first?
Hi Heather
I started home training when I first started dialysis but similar to Pierre did shorter sessions 4/5 hours for first 4 weeks to get bloods worked out. I wanted to do Nocturnal so this was discussed and sorted from Day 1. Then I did about 4 sessions of 8 hours (boring but necessary way to spend sunny days) in my training room before going home. My nurse came out to my home then to watch me set up for a 4 hour session first, before I did my first Nocturnal on my own( which I stuffed up and lost a line of blood because I was too nervous.)
With the benefit of hindsight and because I was only in a small program in the “bush” I think I should have just done short runs at home first, because for me everything seems “scarier” and more stressful at night.
Cheers
Where I went we were trained doing 5-6hrs 3-4 times a week. You are sent home on this regime to get settled and then when a spot comes up for nocturnal, you are trained for that over 2 nights. I think this is a good way to do it, as you are already well trained by the time you are trained for nocturnal. There is hardly anything else you need to learn, just a few little things. One tip when you go in for training, take your own pillows!!
The purpose of starting out with short daily at home is just for the patient to get used to dialyzing at home. Switching to nocturnal is a pretty big step, because you need to have confidence in your machine and yourself, since you will presumably be sleeping through treatments. I guess it’s not absolutely necessary to do it like that, but I think it’s a good policy. Suddenly being on your own at home can be a little nerve-wracking at first.
Pierre
We start on daily because not everyone wants to do nocturnal, and there are only so many that can be trained at any one time. It took me a fair bit of convincing to do nocturnal. I was talking to another patient on it and he was telling me all of the benefits such as diet, better dialysis etc. I can thank him for convincing me.
The other thing is that running for a few months in daylight hours - essentially clinic hours - Mon-Sat, you can ring in, if you have any complications or queries. I think I rang at least once a week, for the first month or so. Gradually it settles down. BY the time I came up for nocturnal, I was pretty comfortable doing it at home, having been doing it for 3months+. 8)
I forgot about that bit Bear 
I ring in a fair bit, probly more now than I used to with the water problems and what not. I try to go in every now and then for a visit, so Im not tying anyone up on the phone.
We called Lynburg Nephrology today to see how they run their program and they said they do not train for SDD at all. Their program is strictly for slow, gentle Nocturnal training. They use a blood pump speed of 200-250 and a dialysate flow rate of 200-300.
They do not suggest to patients that they have their last meal at any particular time of the day. They just teach them how to get off if they have to make a bathroom run during the night.
At no time in my entire history of dialysis (going on 4 years, incl. in-centre conventional, short daily and nocturnal) was a single word ever mentioned about when to eat or not eat…
I’ve only found on my own, for my own purposes, that I prefer to not eat just before nocturnal - simply because I don’t want to have heartburn or reflux during the night (a problem which I was already prone to, even before ever being on dialysis). I have eaten on conventional or on short daily hemo hundreds of time, even complete full-course meals, and I’ve eaten even during nocturnal treatments (during the first hour). I’ve never once had to run to the bathroom. I have no idea why so many of you get the “runs” while you’re on treatment. If anything, for me dialysis is constipating, not the opposite.
Pierre
We have never had to go to the bathroom one single time on in-center dialysis although we see a number who do. But we did wonder if hooked up nocturnally if the urge to use the bathroom ever hit and if eating at a certain time of the day would prevent having to unhook.
At in-center dialysis, like we said, we don’t need to get off. But at home it is different- sometimes have to go early morning or late night. So, wondered if eating schedule can prevent the need to unhook for bathroom?
Also, don’t know about others, but sometimes we have to go to the bathroom quick and that seems like it could be a problem hooked up nocturnally :oops: Just wondered how other handle this.
Hi, all,
We do nocturnal also. Hubby Ralph and I were trained at the same center as Marty. Hubby trained 4 days a week doing 5 hrs each day for 6 weeks.
I attended 2 days a week for 5 weeks and the 6th week I trained all 4 days. We than went home and we did the nocturnal the first night home.
The nurse asked us if we wanted her to come and observe. (I do the setup and his canulation etc) I said that I did not want to have a crutch so we did it ourselves that first night. ( We are monitored on the internet) I knew that if I needed help they were a phone call away. We have been doing it ever since now 25 months home.
As for going to the bathroom once your on for the night- I have a trick I use- when I canulate Ralph I put an extra piece of tape on the Arterial line so that when I have to take him off to recirculate, I know which line is which and I do not have to undo everything. This really works well.
I have also learned that the first thing I do when he has to go to the bathroom is take the UF of and than proceed. This way there is no alarming to contend with. When he returns from the bathroom I just reverse everything.
I am so use to doing this I probably can do it in my sleep.
Pat
Reading over the posts in this thread, I see that most recommend training in SDD first, and then once comfortable, beginning the nocturnal training.
- What about nocturnal training goes beyond what you learned for SDD training?
2)Would doing nocturnal training from about 8 a.m. - 4 p.m. work eventhough it is not done at night while sleeping?
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Do all of you feel a nurse should be with you when you go home with it for the first time?
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How many weeks do you advise doing SDD before one starts training for nocturnal?
What about nocturnal training goes beyond what you learned for SDD training?
With our Fresenius machines, if we are on daily nocturnal, we can also do short daily. The machine has no limitations that way, and in practice, there are times when for one reason or another, a daily nocturnal patient does do short daily treatments. It’s only a matter of adding or not adding phosphorus to the dialysate (maybe calcium also), changing the dialysate flow to 500 for short daily or 300 for daily nocturnal, and running blood pump at max. 400 for short daily and 300 for daily nocturnal. Of course, the amount and duration of heparin are programmed differently. Other than that, short daily and daily nocturnal are identical. The big difference is that you are expected to be sleeping during nocturnal, and not during short daily. As such, you have to be “tested” to ensure you are awakened by alarms and that you can respond appropriately. Blood work is taken during the 3 nights at the hospital in order to determine what dialysate supplements are required. A nocturnal patient will also be required to draw his/her own pre and post tx bloodwork.
Would doing nocturnal training from about 8 a.m. - 4 p.m. work eventhough it is not done at night while sleeping?
Well, it would in terms of duration, but daytime is not the same as night-time. But if you can reproduce the same conditions to turn daytime into night, it makes no difference. Of course, when spending 3 nights in hospital to convert from short daily to nocturnal, you spend them in a hospital bed, not in a dialysis chair. You have to sleep as you would normally.
Do all of you feel a nurse should be with you when you go home with it for the first time?
I think it’s helpful, but not absolutely necessary. It’s just reassuring to have that support there when doing it for the first time at home. It can be a little nerve-wracking the first time. I think it’s also good for the nurse’s confidence level about you being able to do this.
How many weeks do you advise doing SDD before one starts training for nocturnal?
A couple of weeks would be enough, but a month seems like a good compromise. It’s just to allow you to get used to the idea of being on your own. People sometimes don’t realize that real world is different than training. There’s nobody there to bail you out if something happens. Plus, on nocturnal, you have to have full confidence in your setup and your machine because you and everyone else at home will be sleeping during the treatment. There’s nobody coming around periodically to check on you. I think it would be hard though not impossible to start straight into nocturnal.
Heather, this happens to me particularly if I have eaten too much at night before going on. We have our ensuite right next to my side of the bed, so I turn pump speed down to 200 (from 225-250), get up slowly ensuring my arm stays steady and doesn’t go above height of blood pump, hubby pushes Freni to door of ensuite and I walk slowly to toilet etc etc. Not something I would reccommend all the time but when you have got to go , you have…!!
Cheers :lol:
If one must unhook, how long does one have to go to the potti and get hooked back up? Our bathroom is close, but not close enough to move the machine.
If one has to go to the potti fast, I can see where there would be no time to unhook so we are looking into a porta potti although it seems gross to have one in ones bedroom. Quick jolts to the potti aren’t that often but does happen so we want to be prepared.
Pierre wrote:
there are times when for one reason or another, a daily nocturnal patient does do short daily treatments. It’s only a matter of adding or not adding phosphorus to the dialysate (maybe calcium also), changing the dialysate flow to 500 for short daily or 300 for daily nocturnal, and running blood pump at max. 400 for short daily and 300 for daily nocturnal. Of course, the amount and duration of heparin are programmed differently. Other than that, short daily and daily nocturnal are identical.
Do you know exactly how much phos., cal. heparin to use for short txs?
I have an image in my mind of dozens of people at my old dialysis centre running to and fro the rest room all day while the nurses’ blood starts boiling
Of course, this doesn’t happen. You might get one person out of 30 once in a while. Personally, I think you would want to absolutely minimize the need for disconnecting while you’re on a nocturnal treatment. Two reasons:
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The off-chance of low BP after getting up (it’s not like when you get up after taking yourself off in the morning, because you probably haven’t measured your BP, and, you haven’t just given yourself 500ml of saline with rinseback. BP does drop lower during the night as you sleep.
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More opportunity for contaminating the blood circuit and for air embolism, not to mention waking up your partner in the middle of the night to disconnect you.
If you do have to disconnect, the blood in the circuit will not be getting oxygen, and so, you can’t be away too long before you reconnect. I was told 8 minutes. You should check when you get back that the blood hasn’t turned very dark (almost black) from lack of oxygenation, and if it has, you can’t pump that blood back into yourself. You have to abandon the treatment in that case.
Ok, just my opinion, but I think we have to make every possible effort to retrain our bowels to go during the daytime. It will make life on nocturnal so much easier! Don’t eat after late afternoon if it’s a problem for you, and don’t drink too much before or during a treatment if night-time urination is a problem.
Maybe you should get yourselves some Imodium
No offense intended!
Pierre